Intracoronary thrombolysis and stentless primary percutaneous coronary intervention in an ectatic right coronary artery with large thrombus burden.
George KassimisPetros FaliagkasPolykarpos PshochiasEfstratios KaragiannidisEmmanouela PeteinidouEvangelia ChatzinikolaouAntonios ZiakasGeorge SianosPublished in: Future cardiology (2020)
A 58-year-old man was admitted to our center with an inferior ST-segment elevation myocardial infarction. A coronary angiogram showed an ectatic right coronary artery (RCA) occluded at mid vessel by a significant clot burden quantified by micro-computed tomography. Guide catheter-directed intracoronary thrombolysis with low-dose tenekteplase resulted in regaining RCA flow, when numerous efforts of manual and 'mother-child' thrombectomy had failed to achieve. A stentless strategy was followed with final thrombolysis in myocardial infarction 3 flow and angiographically insignificant stenosis remaining in the RCA. The combination of intracoronary thrombolysis and a stentless strategy is a safe and effective treatment in ST-segment elevation myocardial infarction patients with ectatic arteries and large thrombus burden when repeat manual aspiration thrombectomy fails.
Keyphrases
- st segment elevation myocardial infarction
- acute ischemic stroke
- percutaneous coronary intervention
- coronary artery
- st elevation myocardial infarction
- pulmonary embolism
- coronary artery disease
- acute coronary syndrome
- acute myocardial infarction
- low dose
- pulmonary artery
- antiplatelet therapy
- computed tomography
- coronary artery bypass grafting
- coronary artery bypass
- heart failure
- risk factors
- atrial fibrillation
- high dose
- mental health
- left ventricular
- magnetic resonance imaging
- positron emission tomography
- pulmonary hypertension
- aortic valve
- pulmonary arterial hypertension
- transcatheter aortic valve replacement
- magnetic resonance
- replacement therapy